ABSTRACT
Background: Caesarean section (CS) is a potentially life-saving surgery when performed for indicated reasons. The rates of CS deliveries have sky rocketed in the last few years. A CS does not come without complications and risk and therefore its trends in all institutes should be audited for ensuring optimization of obstetric care standards.Methods: The study was conducted as a retrospective analysis of all the CS deliveries for 12 months and their categorization using the WHO recommended Robson ten group classification system; with an aim to evaluate and understand the indication for each CS performed in the institute. The Robson was further subclassified to closely understand the circumstances in which the CS was performed in each group.Results: In this study evaluated a total of 2831 deliveries out of which 1557 (55%) were CS births. Out of these CS births, 48.5% were indicated for emergency indications. Class 5, 1 and 10 were the main contributors to the CS rate with 50.6%, 19.3% and 10% contributions respectively. From a total of 799 patients with previous CS, only 12.1% could have a successful trial of scar. The most common indications documented for Group 1 was foetal distress, cephalo pelvic disproportion and prolonged labour, in decreasing order. Among the singleton pre-terms who had a CS, a majority (92.3%) were operated before the onset of labour.Conclusions: The audit helped to understand the trends of CS in the institute and helped in the realizing that all the CS in the institute has questionable indications. This led to implementation of clinical and administrative reforms to ensure a reduction in unnecessary CS being performed.
ABSTRACT
Background: Intraperitoneal instillations of local anaesthetic agents alone or in combination dexmedetomidine have been found to reduce post-operative pain following laparoscopic cholecystectomy. Aim: Comparing antinociceptive effects of intraperitoneal instillation of bupivacaine plain and bupivacaine with dexmedetomidine in patients undergoing laparoscopic cholecystectomy. Materials and methods: Study was conducted on 100 adult patients of ASA physical status 1 and 2 in the age group of 18 years to 60 years, posted for elective laparoscopic cholecystectomy under general anaesthesia. Patients were randomly divided on an alternate basis into two groups of 50 each. Group B: (n=50) patients received Intraperitoneal bupivacaine 50 ml 0.25% + 5 ml normal saline. Group DB: (n=50) Intraperitoneal bupivacaine 50 ml 0.25% + dexmedetomidine 1 μg/kg with normal saline 5 ml. Results: Mean pain scores were significantly lower in the group BD when compared to group B during the entire duration of the study. There was statistically significant difference in VAS pain score at 6, 8, 12, 18, 24 hours after surgery. Mean pain scores were significantly lower in the group BD Srinivas Rapolu, K Anil Kumar, Syed Ali Aasim. A comparative study on intraperitoneal bupivacaine alone or with dexmedetomidine for post-operative analgesia following laparoscopic cholecystectomy. IAIM, 2016; 3(12): 33-40. Page 34 when compared to group B during the entire duration of the study. There was statistically significant difference in VAS pain score at 6, 8, 12, 18, 24 hours after surgery. There was statistically significant difference between two groups of patients in terms of heart rate, systolic and diastolic blood pressure from 1 hour to 12 hours. 4 patients (8%) of group B and only 5 (10%) patients of groups B + D had postoperative nausea/vomiting, and 7 (14%) patients of group B and 2 (4%) patients of groups B+D had postoperative shoulder pain. Conclusion: Intraperitoneal instillation of dexmedetomidine with bupivacaine prolongs the duration of postoperative analgesia as compared to that with bupivacaine alone.